Acute Pelvic Pain

 INTRODUCTION:

• Pelvic pain is mediated by Autonomic nerves 

 PREMENARCHE:

Congenital causes: 

• Haematocolpos and haematometra

Ovarian cyst: 

• Torsion, rupture haemorrhage and malignancy

Ovarian Tumour:

• Dermoid cysts, teratoma dysgerminomas and germ cell tumours(LAPROTOMY REQUIRED)
• Abdominal tuberculosis(most acute pains)
• Nongynaecological causes

REPRODUCTIVE AGE GROUP:

Obstetrical Causes:

Abortion:

• Inevitable and septic abortion

Ectopic pregnancy: 

• Abdominal pain and short period of amenorrhoea

Red degeneration of fibroid: 

• Seen in case of early pregnancy

Twisted ovarian cyst: 

• Surgery required

Acute hydramnios: 

• More common in a multiple pregnancy, presents with unduly enlarged uterus in mid-pregnancy and abdominal pain.

Molar pregnancy:  

• Pain is due to sudden enlargement of the uterus, haemorrhage and perforation

Retention of urine:

• Retention occurs due to retroverted gravid uterus, haematocele of ectopic pregnancy fibroid or ovarian cyst impacted in the pelvis

Abruptio placentae:

• Occurs after 20 weeks of pregnancy

Gynaecological Causes:

• Dysmenorrhoea:
• Cyclical and related to menstruation

Mittelschmerz: 

• Mid-cycle pain, not lasting more than 12–24 h, around ovulation.

Pelvic inflammatory disease (PID): 

• Pain is mostly bilateral, and abdomen is tender in acute PID.
• Acute pain is felt in the lower abdomen, but may spread upwards if generalized peritonitis ensues.

Endometriosis: 

• Either due to rupture of a chocolate cyst or due to leakage of blood into the peritoneal cavity.
• severity of pelvic pain in endometriosis correlates best with Depth of invasion

Hyperstimulation of induction of ovulation:

• Severity is related to endogenous or exogenous hCG.

Uterine fibroid:

• Results when pedunculated fibroid undergoes torsion or the capsule vessel ruptures with intraperitoneal haemorrhage

Non-gynaecological Causes:

• Retention of urine: Occurs when a tumour gets impacted in the pouch of Douglas
• Gastrointestinal pain:Colicky and associated with gastrointestinal symptoms.
• Abdominal tuberculosis

MENOPAUSAL AND POSTMENOPAUSAL WOMEN:

Pyometra: 

• Occurs in  endometrial cancer following radiotherapy, when the cervix gets stenosed or due to tubercular and senile endometritis.
• Pain is localized in the central portion of the lower abdomen

Ovarian tumour:

• Invariably malignant in an old woman
• Sarcoma in a fibroid

Retention of urine: 

• Menopausal woman due to bladder neck obstruction